Provider Demographics
NPI:1407337256
Name:FITZGERALD, KATHLEEN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 VISTA DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1365
Mailing Address - Country:US
Mailing Address - Phone:256-527-8503
Mailing Address - Fax:
Practice Address - Street 1:2701 MERIDIAN ST N
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-1845
Practice Address - Country:US
Practice Address - Phone:256-852-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR353762225X00000X
DCOT010001200225X00000X
AL4768225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist